It has been said that rowing offers the most intense full-body workout of any sport. Whether that’s true or not is probably a matter for subjective debate, but it’s easy to see why the claim would be made. Rowing pushes muscles and bones to their limits, while revving cardiovascular systems into overdrive. The entire body acts as an engine to propel a boat across the water as fast as possible. All the while, natural conditions such as wind, cold, sleet, heat or the drenching water itself can taunt competitors. It’s a test of strength, fitness, endurance, will and commitment.

Injuries can naturally result from such a pursuit, made all the more complicated by the traditional rowing code of suffering in silence. Pain is something to be conquered, not capitulated to. It’s part of the test. Rowers are motivated not only by proving to themselves they can overcome any obstacle, but also the fear of letting down their teammates in the boat, brothers or sisters all. So how do you convince competitors who pride themselves on being toughest of the tough that sometimes the greater good is served by getting out of the boat to rest and rehab? That’s part of the challenging job of Marc Nowak, PT, MSPT, who for more than a decade has provided physical therapy to members of US Rowing.

Tremendous Training

“It amazes me how much training they do, and how they can mentally and physically tolerate those levels for such a long period of time,” Nowak told ADVANCE. “For most rowers in the national team program, you’re talking about at least a quadrennium. So that’s four to six years of working out constantly, six days a week, two to three practices a day. It’s high-load, long-duration workouts. High repetitive-stress injury levels, just from the constant training. And they’re amazingly tolerant, upbeat and motivated. To be able to do that on a daily basis is tough. Particularly when injury is sustained, because they tend to downplay their injury level.”

US Rowing is headquartered in Princeton, NJ, which is also site of the clinic where Nowak works-Sports Physical Therapy Institute (SPTI). Nowak began working for SPTI in 1992 and specifically the Princeton location in 2002. What began as a few referrals to treat both male and female national team rowers eventually grew to Nowak becoming an official physical therapist for US Rowing. Along the way, he traveled to the 2004 Olympics in Athens, 2008 Olympics in Beijing and most recently the 2012 Olympics in London to provide therapy to national team rowers. For most of the last decade, Nowak served as the only therapy provider for both the

Marc Nowak, PT, MSPT, an official physical therapist for US rowing, has been providing treatment to the men’s and women’s national teams for more than a decade. Here he works with Ian Silveira, a member of the national team program, at a boathouse in Princeton, NJ, where US Rowing is headquartered.

men’s and women’s teams. However, in 2010, the men’s team moved its training operations to Chula Vista, CA, where they now receive treatment from another official team therapist, Reiko Takahashi, PT. The women’s team has maintained its training operations in Princeton, where Nowak continues to provide exclusive PT treatment.

“If you ask a rower with a rib stress fracture what her pain level is, the truth is she basically has pain with every breath she takes, but she’ll say it’s a 4 or 5 on a scale of 1-10,” Nowak related. “The average person would say it’s a 9 or 10. So I typically need to take their pain scale and multiply it. That’s what concerns me most. Particularly for certain athletes, if they even start complaining of a problem, I’ll get them in for treatment. Because if you give that problem a week under those stress levels, it’s going to become major.”

Rib injuries tend to be the most common that Nowak encounters among elite-level rowers. These could range from stress reactions to stress fractures. There are also thoracic spine injuries, shoulder complex issues, and lumbar spine herniations or dysfunction. Erin Cafaro, a gold medalist in both 2008 and 2012 for the US women’s eight-person boat, can speak from experience about many of these occupational hazards.

“My first year in the program, which was 2007, I tore the quadratus lumborum in my back,” she toldADVANCE. ”Then in the spring of 2008, right before the Olympics, I broke a rib. Marc was able to rehab me back into the selection process so that I made the boat for Beijing. In 2009 and 2010, I stayed pretty healthy, maintaining my back and ribs with the help of exercises from Marc. Then in 2011, a month before the World Championships, I broke two ribs – one on each side. We were racing abroad when the first one broke, so Marc wasn’t there to convince me to stop, and that’s probably why I broke the second one too.”

When Cafaro speaks about the job Nowak has done for her, equal parts respect, admiration and amazement emanate from her words.

“I really don’t know what I or the rest of the girls would do without Marc. I literally have his number saved in my phone as ‘The Magic Worker.’ Once they catch on with the national program, most of the girls go see Marc at his clinic at least once a week, even if they aren’t injured or out from practice, just to maintain. Because you always have a weakness cropping up. Maybe it’s your back or ribs or both. You want to make sure it doesn’t get to that degree where you have to stop training or rowing because of injury. He basically helps keep us in the game.”

Different Strokes

There are two distinct types of rowing – sweeping and sculling. Sweeping is how rowers are typically introduced to the sport, even if they eventually become scullers. In sweeping, the practitioner uses both hands to hold one oar, rowing on only the port or starboard side of the boat. A fellow rower sweeps on the other side to provide balance. At the international level, there are three types of sweep boats – pair (two rowers), four and eight. In sculling, meanwhile, the rower holds an oar in each hand. International scullers may compete in the single, double or quadruple event. In some competitions, there are also lightweight and heavyweight divisions for the different strokes.

Nowak hasn’t encountered an increased frequency of injury among one rowing type compared to the other. “I’ve seen just as many injuries with scullers and sweepers,” he related. “A lot has to do with sheer training volume as much as the style of rowing. So you’ll have fatigue setting in, overtraining, overstressed tissue just due to repetition. And that will attack both rowing groups.”

He noted, however, that injuries to sweepers are more commonly due to musculoskeletal imbalance.

“There tends to be more asymmetry in the sweep rowers, since you’re pulling predominantly from one side. So you commonly see strains or sprains more on one side than the other. It also sets up mild, and sometimes more than mild, functional scoliosis. Because a sweep rower has been sweeping for many years. At the high school and college levels, competitors mainly sweep. In the United States, most scullers don’t start that discipline until they’re already elite as a sweep. I think people who have sculled from the beginning are a little better off since they tend to be more technically savvy and have trained both sides of their system. But it’s just not that common.”

Nowak did say he believes female rowers are more susceptible to injury than male.

“Particularly for rib stress injuries, you’ll see predominance with women. And also with the lightweight men, although probably to a lesser degree. I think it has to do with force and work-to-bodyweight ratio. The heavyweight men are often 6-foot-4 or 6-foot-5, 200-pound-plus guys with a lot of muscle mass. The women are not as strong in the upper half of their bodies, especially the shoulders. And the lightweight men pull just as hard as the bigger guys, but they don’t have the weight or often the length to help with that. So your lever is shorter and you’re working harder. Therefore your breakdown is usually a little more frequent.”

Male or female, lightweight or heavyweight, Nowak couldn’t speak more highly of rowers as a patient population.

“They’re the best,” he said. “Very disciplined, educated and responsive to treatment. They want to row so they’re very motivated and encouraged to eliminate their problem, get back in the boat and compete with their teammates. They’re just an awesome group to interact with, very appreciative with a great sense of humor. I worry about them more because they won’t limit themselves until breakage. That’s their motivation level. They are elite and will take punishment you or I would not. There’s a reason why they’re out there.”

London Calls

Certainly Nowak’s Olympic experiences have ranked among the highlights of his involvement with US Rowing over the years. He talked to ADVANCE about his experience in England a few months ago for the 2012 Games, where he helped treat both the men’s and women’s teams.

“London was great. The setup for rowing was wonderful and the volunteer system was amazing. Whatever help you needed, they had people there to guide you along the way. They put up tents for the rowers with exercise bikes and [ergometer] machines. We had a tent for rehab right at the water. The venue itself was beautiful and the crowd was amazing. I’ve never heard cheering for rowing before like there was in London. The Brits are very into it and the sheer crowd noise when rowers were coming to the finish line was just deafening.”

To be part of that level of enthusiasm for the sport was exciting not only for Nowak, but also the rowers themselves. “Entering the last 500 meters with that kind of crowd, none of them had experienced it before, even at other Olympics,” Nowak added. “It was just tremendous.”

Overall, the US men’s and women’s teams performed well, combining for three medals, with two other US boats each coming within 0.3 seconds of the podium.

“I got to watch the events on closed-circuit TV,” Nowak related. “You stop working, run over, catch a race on TV, jump up and down and then get back to work again because there are other rowers who need treatment. It’s that kind of experience, which is very special. You’re in it and watching it, dealing with the good or bad. For the rowers, if they come back to the tent and didn’t do well, you’re trying to help with their frustrations in addition to their physical ailments. But when they do well, everything feels great to them. Nothing cures any problem better than a gold medal.”

Brian W. Ferrie is managing editor of ADVANCE and can be reached at bferrie@advanceweb.com